Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, The Netherlands.
BMC Fam Pract. 2013 Aug 10;14:114. doi: 10.1186/1471-2296-14-114.
The need to understand barriers to the implementation of health care innovations in daily practice has been widely documented, but perceived facilitators and barriers in diabetes care by Dutch health care professionals remain unknown. The aim of this study was to investigate these factors among health care professionals (HCPs) using a qualitative research design.
Data were collected from 18 semi-structured interviews with HCPs from all professions relevant to diabetes care. The interviews were recorded and transcribed verbatim and the data were analyzed using NVivo 8.0.
Major facilitators were the more prominent role of the practice nurses and diabetes nurses in diabetes care, benchmarking, the Care Standard (CS) of the Netherlands Diabetes federation and multidisciplinary collaboration, although collaboration with certain professional groups (i.e. dieticians, physical therapists and pharmacists), as well as the collaboration between primary and secondary care, could still be improved. The bundled payment system for the funding of diabetes care and the role of the health insurers were perceived as major barriers within the health care system. Other important barriers were reported to be the lack of motivation among patients and the lack of awareness of lifestyle programs and prevention initiatives for diabetes patients among professionals.
Organizational changes in diabetes care, as a result of the increased attention given to management continuity of care, have led to an increased need for multidisciplinary collaboration within and between health care sectors (e.g. public health, primary care and secondary care). To date, daily routines for shared care are still sub-optimal and improvements in facilities, such as registration systems, should be implemented to further optimize communication and exchange of information.
人们广泛认识到需要了解医疗创新在日常实践中的实施障碍，但荷兰医疗保健专业人员在糖尿病护理方面的感知促进因素和障碍仍不清楚。本研究旨在使用定性研究设计来调查这些因素。
从所有与糖尿病护理相关专业的 18 名医疗保健专业人员的半结构化访谈中收集数据。访谈进行了录音和逐字记录，并使用 NVivo 8.0 对数据进行了分析。
主要促进因素是实践护士和糖尿病护士在糖尿病护理中扮演的更突出角色、基准测试、荷兰糖尿病联合会的护理标准（CS）和多学科合作，尽管与某些专业群体（即营养师、物理治疗师和药剂师）的合作以及初级保健和二级保健之间的合作仍有待改善。用于资助糖尿病护理的捆绑式支付系统和健康保险公司的作用被认为是医疗保健系统内的主要障碍。报告的其他重要障碍是患者缺乏动力以及专业人员对糖尿病患者的生活方式计划和预防举措缺乏认识。
由于对护理连续性管理的关注度增加，糖尿病护理的组织变革导致医疗保健部门内部和之间（例如公共卫生、初级保健和二级保健）对多学科合作的需求增加。迄今为止，共享护理的日常工作流程仍然不理想，应该实施设施改进，例如注册系统，以进一步优化沟通和信息交流。
